By Joe Firestone, Ph.D., Managing Director, CEO of the Knowledge Management Consortium International (KMCI), and Director of KMCI’s CKIM Certificate program. He taught political science as the graduate and undergraduate level and blogs regularly at Corrente, Firedoglake and Daily Kos as letsgetitdone, and Lambert Strether, who blogs at Corrente. Joe did the heavy lifting on this!

Many people, and especially Obama supporters, characterize the ACA (ObamaCare) as “just starting” or a “work in progress” and then go on to urge that the program will have “glitches,” needs to be “tweaked,” isn’t yet “fully implemented,” and so forth. We think it’s a mistake to see the ACA as just starting. We also think it’s a mistake not to weigh the costs of ObamaCare’s stately three-year progress toward partial coverage for the the American people, and just as important to weigh the opportunity costs.

The Democrats even saw to it that the bill was fiscally neutral over a 10 year projection at a time when the tanked economy needed more deficit spending and the jobs that would have brought. And to do that, they postponed implementation of most of the bill for more than three years, until now, allowing people to go without care, to die, to divorce, and to lose their homes or go bankrupt due to medical bills, just so they could argue that the bill was fiscally neutral. In gauging the record of the bill, these 3 to 3.5 years of waiting for its implementation and their real costs to the people of the United States must be taken into account.

When the ACA was passed it was estimated by its proponents that it would cover 35 million more people than before. Now these same proponents are using the figure 31 million new people covered instead. Meanwhile the population of the United States has grown by 9 million people, and due to the effect of the crash of 2008, millions of people who were insured before the crash are now uninsured. So, though there are no hard figures on this it is likely that estimates of 30 million still uninsured are on the low side. And when we consider that HHS, today, for actuarial reasons, is marketing to the young and healthy, and not the vulnerable and disengaged, it seems quite possible that the 45,000 fatalities per year will not decrease significantly, if at all.

Even if the projection of 31 million new people covered is accurate by say 2017, we will still have as many (assuming further population growth) as 28 million uncovered people then, because the Democrats chose to pass the ACA rather than the Conyers/Kucinich enhanced Medicare for All bill, HR 676. So, 9 years after the effort to pass universal health care started in 2017, we would still have 28,000 fatalities per year to cope with and 28 million going to emergency rooms for care that is too little and often too late (assuming that regulations and laws are not changed to tighten up or eliminate ER access, using the ACA as a pretext).

Furthermore, it’s perfectly possible that the current 31 million new coverage projection is still too optimistic about the future. Many states are still fighting the ACA and will not implement its Medicaid provisions. Some 17 million out of the 31 million new people covered were going to go into the expanded Medicaid program. But with State Governors in Southern and some Western Red States refusing to allow that Medicaid expansion to occur, we may end up with only 9 million new Medicaid enrollees nationwide. Many others will try to game the system because they are willing to accept the risk of mandate violations and fines rather than pay the cost of the lousy insurance offered for basic plans in the ACA.

All in all that 31 million may well turn into 17 million or so before all this is done. And then we would have taken 9 years of passage, waiting, and implementation and would still have as many as 40 million people uncovered in 2017, and 40,000 annual fatalities.

That is the measure of the possible failure of the ACA.

Is that better than nothing? Sure, but you also have to take into account the opportunity cost of what was done in 2009 to work towards and then pass the ACA in 2010. What if the Democrats had ignored the Republicans in 2009, and used reconciliation or elimination of the filibuster and their big majorities in both Houses to try to ram through HR 676?

I think they would have succeeded because Nancy Pelosi had full control of the House, and with elimination of the filibuster and even reconciliation they would have needed only 50 votes + 1 (the VP) in the Senate to have passed that bill in the Spring of 2009, and implemented it by January 2010. Then there would have been no rise of the Tea Party, no sabotaging of the ACA, and full coverage for everyone with no co-pays.

That’s what we’ve lost by not trying to pass HR 676 and by trying instead to take a bipartisan insurance company conciliation approach to passing the ACA. This post, gives the total for the anticipated opportunity cost by comparing Romney’s 2012 alternative to the ACA, the baseline of no reform at all, the ACA, and Medicare for All over the period 2010 – 2022. Bottom line: the ACA is projected to cost 286,500 lives through 2022, assuming no change. That’s a lot better than the baseline and a lot better than Romney’s 2012 alternative. But it’s still terrible compared to what we might have had if we had a President who really represented people rather than Wall Street.

What if an effort to pass HR 676 had failed in 2009 because too many Democrats in the Senate defected to pass it? Well, I think this would have been very unlikely with the very large Democratic majority and the popularity of the president at its height, but even if it would have failed, then the Democrats could still have compromised with members of their party to pass enhanced Medicare for All for everyone under 26 and over 45, or under 26 and over 50, or whatever compromise would have moved those wayward Democrats up to the 50 vote mark. Such a compromise bill would still have lowered the fatalities substantially by providing insurance for those who needed it most and by enhancing the Medicare program for seniors (full coverage and no co-pays). It would also have been something Democrats could have run on and built upon in each successive election year, rather than having to defend the sorry ACA with its package of inadequate goodies, silly mandate, IRS enforcement, high cost for lousy coverage, and Rube Goldberg eligibility determination. Again there would have been no Tea Party, because Tea Partiers like Medicare, and there would have been no Republican nationwide sweep in 2010, no gerrymandering, no voter suppression, no anti-woman bills, and none of all the rest of the nonsense we’ve seen because the Democrats did what they did.

About Lambert Strether

Lambert Strether has been blogging, managing online communities, and doing system administration 24/7 since 2003, in Drupal and WordPress. Besides political economy and the political scene, he blogs about rhetoric, software engineering, permaculture, history, literature, local politics, international travel, food, and fixing stuff around the house. The nom de plume “Lambert Strether” comes from Henry James’s The Ambassadors: “Live all you can. It’s a mistake not to.” You can follow him on Twitter at @lambertstrether. http://www.correntewire.com

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170 comments

Let’s not also forget that these same Congress critters, while they were busy bitching about the latest iteration of a corporate giveaway, were protecting themselves and their own families with health care policies that were deemed too expensive for the general American public.

It was the White House critter more than the congressional critters who are ultimately to blame for destroying public options and turning “Obamacare” into a private sector bonanza. Among many crucial turning points, please recall perhaps the worst: Pelosi and Reid had finally agreed to use reconciliation in order to expand the public role when suddenly Obama stepped in, pulled rank, and held a meaningless and pompous televised big meeting of all the critters. From that moment on he talked only about his own monkey-wrench plan and proceeded as if the Pelosi-Reid talk of reconciliation and public health insurance had never existed. It was completely vaporized. This was a coup by the WH and the private insurance industry and sealed the fate of Obamacare as it is. The buck stops with Obama.

This article is an excellently documented set of reasons why we should temporarily keep this Obamacare kludge and call for Obama to take early retirement.

(for those not familiar with the definition, a kludge is 10 pounds of feces in a five pound sack.)

The only reasons for keeping it is that a few people have already benefited from a small number of its provisions.

The worst of Obamacare might be used as a bargaining chip, not with the Republicans, but with the public – give the Democrats back a house majority and they will eliminate co-pays for all government affiliated medical plans and will move in the direction of a single-payer system.

The bargaining chip with Democrats would simply be: use your majority to fix medicare, or join Obama in early retirement.

Those who speak of “medicare for all” need a little more knowledge about what medicare actually does for people. You might look at the site ( ntlsystems(dot)com/cptr ) to see what can happen when you are covered by medicare but lack the income to actually receive necessary medical care.

The call for “Medicare for all” is, I think and HOPE, a call for form over substance. Every time I hear it I cringe just a little.

As currently operated, Medicare is an example of some of the worst of what happens when government blank checks are written to private “businesses.” No procedure, no matter how thinly justified, is refused for payment. Basic business principles like negotiating for volume discounts become prohibited BY LAW.

The article here a few weeks ago describing how Medicare fees are set and the Bloomberg article the other day on the overuse of stents are evidence that merely putting everyone on the Medicare train will not solve America’s “healthcare” problems.

The entire system of procedural piecework profitability must be reformed, not just how it’s paid for. Come to think of it, we should probably also take a look at what is considered “healthy” these days as well.

To your objections to Medicare could be added its disastrous financing shortfall. According to the US Treasury (Table 6, page 189), Medicare’s infinite horizon financing shortfall is $43.1 trrrrrrrillion:

Expanding Medicare eligibility to younger cohorts would only dig a deeper black hole, cranking Medicare’s underfinancing from 16 times the federal budget at present to 20 or 30 times the annual budget.

Wheeeeeeee — too big to count, too big to fail, too big to fix!

Or as my buddy Fyodor Dostoyevsky used to say, ‘So things are bad? Well then, let them get even worse!’

When you repeat something said by a reporter from FOX, you really, really need to check your work.

“The next problem is less debatable: the information is outdated.

According to the latest Medicare and Social Security trustees reports, the numbers have changed significantly since 2009. Promised Medicare benefits for the next 75 years now total $24.6 trillion, according to 2011 numbers, and Social Security benefits have increased to $9.2 trillion.

So Medicare obligations are now $13.6 trillion less than the data upon which Wolf based his claim , largely due to the health care reform act passed last year. Social Security obligations are $1.5 trillion trillion more. The net effect of those changes is that projections for future obligations are $12 trillion less than the 2009 data Wolf uses.

[…]

Other numbers have changed, too, but you get the point: The 2009 estimate was not a safe number in April 2011. [PolitiFact, 5/23/11]

The “unfunded liabilities” argument is misleading for another reason. It is only applied to programs that, like Social Security and Medicare, are paid for by a dedicated tax like a payroll tax. The projected gap between future revenues and future outlays from this special-purpose tax is the “unfunded liability.” Why do we never hear of the “unfunded liabilities” of Pentagon spending — the third of the big three spending programs (Social Security, Medicare, defense) that take up most of the federal budget? Defense spending comes out of general revenues, not a dedicated tax.

Suppose that in an alternate Rod Serling universe our other-dimensional twins paid for Pentagon spending on the basis of a dedicated national consumption tax, while they paid for Social Security and Medicare out of general taxation. In that case, opponents of Pentagon spending might have a field day denouncing the gap between the estimated federal consumption tax revenues in, oh, let’s say, 2050 and the military threats they estimate that the U.S. will face in half a century. But in this “Twilight Zone” America, neither Social Security nor Medicare, lacking dedicated taxes, would have “unfunded liabilities” any more than the Pentagon does in our world. [Salon, 5/19/09]”

If we stuck to this universe and eliminated other world accounting gimmicks like the unified federal budget looking glass, we could split out direct funded programs like SS and Medicare, where we clearly see where our payroll deductions on our paychecks leave our reality, but then, sadly, they all converge in federal tax revenue space, and we then have to rely on government accounting physicists to explain where our money went.

If we take the simple classical view and took SS and Medicare dedicated revenue and subtract it from SS and Medicare outlays, then we could make a federal budget pie chart of federal spending by budget item of the rest of spending funded by “general” revenue and deficit spending.

Barry Ritholz published a chart on his blog a few months ago that was just that. It showed defense spending is 50% and Medicare is 20%. (the Medicare shortfall vs payroll deductions) But if we spend double what the ROW pays for healthcare and drugs, that’s not so surprising. There was a tiny sliver of pie, less than 1% for SS because the surplus went slightly negative the past few years. But this amount is still within the amount paid for interest on the SS Trust Fund – the size of the fund is still growing a tiny amount because it’s earning around 4% interest.

First, HR 676 carries with it a funding mechanism that eliminates shortfalls. Second, HR 676 would save about 1 Trillion per year in total Medical costs, or about $12 Trillion over a decade. Set against this, the additional cost to the Federal Government isn’t relevant, especially since the new taxes specified in HR 676 will cover the extra Government spending. Putting this another way. Medical costs to the private sector, not covered by Government are about $1.8 Trillion annually. HR 676 would cut these costs to nearly zero. So, assuming taxes increase by $800 B to cover increased Government spending, the public (the private sector) still gains $1 Trillion annually.

Third, even if we assume that taxes to pay for HR 676 aren’t enacted, the program can still be paid for by the Treasury minting a platinum coin to cover the deficit spending involved. The deficit spending will create jobs. How do we know? Because demand leakage due to savings desires and our current account deficit would amount to 10-11% of GDP, if accommodated. That’s about $1.6 T annually. The $800 B in new deficit spending is still only half the amount we need to get to full employment. For a comprehensive treatment on using platinum coins including the reasons why using them won’t lead to inflation, see: http://bit.ly/WhUF6e

Way to go, Joe! That’s compelling backup to the post, which I recall you’ve convincingly detailed here before. Sold, except the part about Dems getting it done. I just can’t imagine that in this universe. Too bad Obama avoided it like the plague.

Thanks to you and Lambert for all the heavy lifting, especially adding all that data in the Medicare column ;-)

FYI – Since 2009 Medicare becames means-tested. My husband and I pay premiums of $700/month (for the two of us) for our Medicare, while my brother pays only $125/month. And all three of us get the same care. For that we are thankful and happy to pay the differences in premiums.

And yet, Medicare:
-spends less per beneficiary (when adjusted for health levels) than any private insurance program
-wastes less in administrative overhead
-has higher satisfaction rates among its beneficiaries than private insurance plans

Yep. A real disaster of a government program. And as for being prohibited BY LAW from negotiating for discounts, THAT LAW can be changed, just as it has been for medicaid and other government health programs. But even without that law being changed, medicare spending is still less than private insurance.

But actually, you’re right about one thing: Medicare isn’t the best government health plan out there. Guess which one is? The VA. Yes, those old dingy buildings with their 60s era naughahyde furniture may not compete in creature comforts with the lavish lobbies and patient rooms of private hospitals, but the V.A. system consistently delivers better health outcomes with lower costs than any private insurer out there.

The irony about conservatives who claim that public health programs never work and that the examples of the countless other countries who make just such programs work very well indeed, is that in the U.S., we have pretty much *every* type of public program used in the rest of the world implemented, and *every* single one of them works better than private insurance, and yet conservatives still say we can’t make it work. Even though each one is already working. Within our very own borders!

Let’s see: Britain has NHS? We have the VA, run very similarly. You prefer France’s system? Welcome to Medicare. We even have an example of a well-regulated private insurance market: FEHBP (Federal Employee Health Benefits Program) that works far better than the whole ACA monstrosity.

Winston Churchill once said Americans can be counted on to do the right thing once they’ve exhausted all the other options. And yet, here, America has tried all the other options, implemented each one for a different segment of its population, has somehow managed to make them work far better than the private insurance market, and *still* doesn’t do the right thing.

Quite frankly, I don’t care whether I get Medicare, the VA, an expansion of FEHBP, heck, even DoD’s TriCare. Every single one of them is better than the ACA, and blows away the current system we have.

Hope for a Change to Medicare for all if you wish, but just keep in mind that if a US citizen covered by Medicare experiences many major medical problems he can fly to Colombia and pay for private medical care at a cost no more than his co-pay would cost if he remains in the US.

I thank you for your definition of “kludge” I am now enriched by it–I had used the word without really knowing what it meant now my imagination can soar.

I am gradually coming to the conclusion that maybe we should just give it up and join the right in tearing down the system. It exists to enrich the rich and ignore the rest of us. The mainstream media is pure advertising/PR and honor, courage, or any virtue really barely exists. I find myself defending the ACA even though it’s not defensible against right-wingers who oppose it for the wrong reasons. They don’t like it because they believe the general public will be paying for health-care for the poor and the rightists want the poor to die-off, frankly. That’s an ugly vision. However they are right it one thing–it is and was a bill that was imposed from above without much consultation with the facts or the people.

As for Medicare–it’s probably a mess but I don’t have the energy to look into it. Everything I look into and research related to the government seems to be rotting. Corruption is the worst I’ve seen it.

Most of the right doesn’t want to “tear down the system”. They just want to tear down the black guy. When Bush was President, they were authoritarians. Now that the black guy is president they are libertarians. If another Republican becomes president they will go back to being authoritarians.

A lot of right-wingers bombard my facebook news feed. As far as I can tell their thinking passes straight from their asses, up the spinal column and out their mouths. It is not influenced by any empirical data or higher primate cognitive processing. It’s just random emoting. They make up bizarre stories and pseudo-facts and pass them around inside their own circle. The volume of ignorance is deeply profound.

Yesterday, I had to argue with people who were convinced that the President spends by executive fiat.

I think the racism angle is there but it isn’t dominant. The growth of the extreme right has been going on for quite some time and the demonization of “them” is broad. Clinton, hardly a leftist, was the focus of unending harassment by the right for his entire term just because he was a “them.” What fuels the right-wing is not policy but tribalism. It is anti-intellectual in the extreme, feeds on resentment and is, above all, a cri de coeur against the modernist project in particular and the career of Western civilization in general. It is profoundly anti-Christian and anti-humanist. It is not fascist even because there is no “vision thing” to it. Its ideology tends towards nihilism. It could be Hilary in office, it could be Kerry in office or anyone and the anger, hatred would be the same. The fact Obama has African blood is the spice not the main dish.

Fair enough. But I’ll still say that 90% of any current right-wing melodrama and histrionics about bringing down the system is bullsh**, and that it will disappear rapidly if they succeed in the much more minor task getting rid of the Democratic president.

Maybe, but I’m not so sure–I think people are not happy with the status-quo and are aware that the rich and the bosses are a big problem–most of these people are kind of fatalistic about that, particularly the older people. Younger people working-class people are more open to the message of the left.

2. n. A clever programming trick intended to solve a particular nasty case in an expedient, if not clear, manner. Often used to repair bugs. Often involves ad-hockery and verges on being a crock.

3. n. Something that works for the wrong reason.

4. vt. To insert a kluge into a program. “I’ve kluged this routine to get around that weird bug, but there’s probably a better way.”

5. [WPI] n. A feature that is implemented in a rude manner.

Nowadays this term is often encountered in the variant spelling ‘kludge’. Reports from old farts are consistent that ‘kluge’ was the original spelling, reported around computers as far back as the mid-1950s and, at that time, used exclusively of hardware kluges. In 1947, the New York Folklore Quarterly reported a classic shaggy-dog story ‘Murgatroyd the Kluge Maker’ then current in the Armed Forces, in which a ‘kluge’ was a complex and puzzling artifact with a trivial function. Other sources report that ‘kluge’ was common Navy slang in the WWII era for any piece of electronics that worked well on shore but consistently failed at sea.

However, there is reason to believe this slang use may be a decade older. Several respondents have connected it to the brand name of a device called a “Kluge paper feeder”, an adjunct to mechanical printing presses. Legend has it that the Kluge feeder was designed before small, cheap electric motors and control electronics; it relied on a fiendishly complex assortment of cams, belts, and linkages to both power and synchronize all its operations from one motive driveshaft. It was accordingly temperamental, subject to frequent breakdowns, and devilishly difficult to repair — but oh, so clever! People who tell this story also aver that ‘Kluge’ was the name of a design engineer.

There is in fact a Brandtjen & Kluge Inc., an old family business that manufactures printing equipment — interestingly, their name is pronounced /kloo�gee/! Henry Brandtjen, president of the firm, told me (ESR, 1994) that his company was co-founded by his father and an engineer named Kluge /kloo�gee/, who built and co-designed the original Kluge automatic feeder in 1919. Mr. Brandtjen claims, however, that this was a simple device (with only four cams); he says he has no idea how the myth of its complexity took hold. Other correspondents differ with Mr. Brandtjen’s history of the device and his allegation that it was a simple rather than complex one, but agree that the Kluge automatic feeder was the most likely source of the folklore.

TMRC and the MIT hacker culture of the early ’60s seems to have developed in a milieu that remembered and still used some WWII military slang (see also foobar). It seems likely that ‘kluge’ came to MIT via alumni of the many military electronics projects that had been located in Cambridge (many in MIT’s venerable Building 20, in which TMRC is also located) during the war.

The variant ‘kludge’ was apparently popularized by the Datamation article mentioned under kludge; it was titled How to Design a Kludge (February 1962, pp. 30, 31). This spelling was probably imported from Great Britain, where kludge has an independent history (though this fact was largely unknown to hackers on either side of the Atlantic before a mid-1993 debate in the Usenet group alt.folklore.computers over the First and Second Edition versions of this entry; everybody used to think kludge was just a mutation of kluge). It now appears that the British, having forgotten the etymology of their own ‘kludge’ when ‘kluge’ crossed the Atlantic, repaid the U.S. by lobbing the ‘kludge’ orthography in the other direction and confusing their American cousins’ spelling!

The result of this history is a tangle. Many younger U.S. hackers pronounce the word as /klooj/ but spell it, incorrectly for its meaning and pronunciation, as ‘kludge’. (Phonetically, consider huge, refuge, centrifuge, and deluge as opposed to sludge, judge, budge, and fudge. Whatever its failings in other areas, English spelling is perfectly consistent about this distinction.) British hackers mostly learned /kluhj/ orally, use it in a restricted negative sense and are at least consistent. European hackers have mostly learned the word from written American sources and tend to pronounce it /kluhj/ but use the wider American meaning!

Some observers consider this mess appropriate in view of the word’s meaning.

The Hacker’s Dictionary (originally the Jargon File) is a wonderful resource that even, or perhaps especially, the non-technical should read.

We need to stop framing Obama’s cut-throat neoliberal policies as missed opportunities or political miscalculation.
Obama could have done this, Pelosi might have done that…are you kidding?
Obamacare was installed in order to kill real reform, full stop.
Mission accomplished.

Our local corporate rag ran a piece the other day about our state exchange and the “glitches” it will likely have (won’t be able to accept payments till Jan.). What I found somewhat surprising is that our Montana Health Insurance Exchange will allow Montanans to select between three different providers. Can we say oligopoly? They’re not even trying to make the insurance market look competitive…

Well, JF, I also argued at the time the “debate” was going on that ACA is not better than nothing but worse, much worse. The Democratic Party suppressed debate on the other options not by debating the merits but by not mentioning the salient facts.

The debate over ACA featured to sources of political malignancy that the left has not faced to this day. One is that the mainstream media left, right and center is just another branch of public relations–all propaganda all the time. The whole health-care “debate” was no debate–it was almost 100% fact-free.

The ACA and the left’s support of it also showed that the left is not the left–it is some joke–like the Stasi “left” in East Germany–the left mouths platitudes and every now and then squeals “it’s not fair” and then goes back to sleep comforted by their moral superiority and ignoring real politics.

Let me tell you what opposing the ACA would have gotten us and still could. Doctors and health-care professionals were getting ready to get together and urge reform along sane grounds, particularly nurses. These people were working to reform the system without government help so that once this movement got under way the presstitutes would have been forced to cover their actions to some degree and grass-roots movements, I believe, would have arisen and reform would have come from the people not the bottled-water filled rooms of Washington hotels, dinner parties or bars.

The right may be destructive but they have one thing right–this ACA was imposed on us from the top-down. It is not as bad as they say but they are right–no one consulted the people or had any respect for what the people wanted or allowed a debate to occur in a public way–rather they insisted on debating it through secret deals and God knows what kind of sordid maneuverings.

In the end, the vast majority of the American people have still no clue at all what the rest of the world does or what a sane system is. The PR/Media industry will never tell them nor will the fake progressives of MSNBC who make their money out of scaring the bejeeus out of “progressives” who are scared to death of gun-toting right wing barbarians. As someone who lives among these sorts of people I can assure you they are not the caricatures that the left believes they are–not even close–and yes, they need to be opposed but not by shaking with fear.

There are scary people out there who really like scaring people. And I’ve been around them. Often, you’ll find that not being scared by scary people can defuse these people. You can always find scary guys just hang out at bars where bar-fights happen regularly–I know of one place not too far from my house but so what?

Most right-wing gun toting people I know are not scary to me. They’re just guys who like trucks and guns and dawgs. They are generally people who aren’t well developed intellectually but they’re rather ordinary in every other respect and have no interest in shooting people unless they are attacked. Many would be more progressive if they were exposed to progressive ideas and the left in this country has done very little to address these people so the result is that progressives are seen as scary suburban elitist who don’t care about anyone and speak with forked tongue so to speak–and for the most part they have a point.

The Right has viciously villanized unions and poor people and any working Americas who want decent wages and health care saying they are lazy and don’t deserve it while glorifying the rich.

And the gun toters fall for it because Right Wing Hate Talk has soaked their not-too-bright brains in this propaganda for the criminal elite for 25 years now.

End result, they are hopelessly lost and will continue to vote against their own interests until they are impoverished. And then they will blame the unions and the poor even more instead of the true criminals in this country, the elite.

It is the fundamental vanity of the prissy left that their “progressive” ideas are not understood (or are misunderstood) by those who find their advocated policies risable.

This is exactly why they are susceptible to passing trainwreck legislation completely disconnected from reality and — worse — their denial of any reality which does not stroke their confirmation bias.

In this particular case, it appears many of these urbane geniuses have figured out (after the fact) that they passed this legislation by themselves, will end up funding it by themselves, and will end up owning it by themselves.

Yep, if they just got rid of the filibuster we could have had a public option, so the ACA sucks. Yep, if they had just used reconciliation we could have had Medicare for all, so the ACA sucks.

Yep, let’s not make any comparisons between what we had before the ACA; let’s make comparisons between a healthcare system that is a political fantasy and trash the ACA for not fulfilling that fantasy.

And while we are living in our liberal fantasy world of the “reconciliation” and “getting rid of the filibuster”, we have to make sure we also forget the Supreme Court and their actions the last decade or so.

We have to make sure that we cannot allow ourselves to think it is possible this court could interpret Article One, Section 5 of the United States Constitution in ways that would have disastrous effects on our government while our fantasy is played out.

After all, just because we have watched this group rape the First Amendment (Citizens United) and the Commerce Clause(ACA), there is no reason to think they may actively apply a never before seen interpretation to the Constitution that would allow government by the minority, or at least no government by the majority.

I submit to you that a rational health-care system is not a fantasy. Every developed and many developing countries have rational health-care systems that are not created to serve the needs for criminally minded oligarchs to make massive amounts of money on people. The ACA is a load of garbage created to stop the move toward health-care reform.

HC reform would have happened from the ground up had ACA been rejected. The industry was working on it by itself on many fronts. Medical professionals fed-up with the massive corruption in the system were ready to advocate for real reform and, in my view, would have by now agitated for a sane system. ACA is not sane it puts some duct tape here and there and lulls us into some false sense of security. It was a back-room deal made by a corrupt center-right government and supported by cowardly progressives who had, in fact, no faith in the people and believe that solutions to problems can only come from the top-down.

Medical professionals were beyond fed-up and I think they would have been the vanguards–particularly nurses. The ACA blunted that movement that I believe would have brought out the facts–once a large group like the nurses and many doctors insisted on a fact-based solution then real reform was possible. Because the “debate” was never fact-centered real reform was impossible. The mainstream media has to be forced kicking and screaming to report facts even mean-spirited people are occasionally persuaded by facts. As for earlier decades–the situation wasn’t as depserate I think it had become desperate by 2009 and still is–but now people are used to it. People have become more passive and just accept the fact that they can’t fully take advantage of the health-care system if they are marginal.

Forget about Blue Dog Democrats, not a single Democrat; not Sanders, not Kucinich, not Grayson, n-o-t a s-i-n-g-l-e o-n-e o-f t-h-e-m, put up any resistance at the end.

What we ended up with was a bunch of endless arguments amongst ourselves about how many poor Americans on the head of a pin are going to get sucked up into a voracious system where they MUST pay higher and higher fees for an absolutely useless commodity in so far as the co-pays for any serious procedure will be so far beyond anything they can afford as to be the pure stuff of darkest humor.

There is only one central feature about ACA that means any thing or that merits any discussion in the long run and that is the fact that we are MANDATED to buy this crap. That is what Obama and his corporate masters wanted and they were willing to throw out a little temporary “bait” to get.

We are being trained. We are being led step by step, generation by generation to accept the idea that our government can force us to swear fealty or homage to corporate hegemons and to indemnify their profligacy with mandatory tribute (and a hat tip to Randall Amster for that last line).

Well, pretty strong challenge. Polls showed that people were open to schemes like single-payer. Nurses were in open revolt in many areas and were militantly arguing for reform. Doctors tired of spending half their money on paperwork wanted some kind of reform and were working with some non-profits to find a way to create more free-clinics, have special rates for non-insured, some were organizing to create cooperatives and partnerships with other doctors–they were searching–I talked to people. Of course that is not “proof” but this is not a court of law. And I don’t have time and you don’t have the money to pay me to make that case using clear proofs.

The desire was there, Obama and his minions catered to that co-opted the movement and destroyed, in my view, all the little “green shoots” of reform. If they had simply presented the facts, allied themselves with the grass roots, enlisted the health-care providers (as opposed to the “industry”) real health-care reform would have come to pass with input from those that provide health-care rather than back-room deals with insurance, big pharma and the hospital industry. The ACA was a cynical attempt by oligarchs to put-off and delay real reform and it succeeded. I’m not denying that there are some benefits to the ACA but it misses the source of what makes the system spectacularly inefficient and costly.

(1) ACA is a mandated giveaway to a rentier appendage – the insurance industry – that has (2) a state assured monopoly over (3) a product – medicine – that every single person is willing to pay every last cent for when they are sick, and remain deeply committed to when healthy.

(4) The system, like the banks, is effectively allowed to self-regulate. And it has done so in the form of $150 rebates towards the 80/20 watermark. Based on internal accounting, those checks come in the face of (5) an average increase of $730/year/family since the bill was passed* and the expectation that (6) once ACA goes into effect those same families should expect continuing premium increases of $600 – $1000/year** .

(7)Those increased costs – $16,000 for a family of four in 2013 – come during a depression. Fewer folks are working fewer hours for a lower wage than, say, 1999 when premiums were $5800.

The fantasy is that ACA is sustainable – that people will find a way to afford it.

The fantasy is that free riders are the problem, that forcing 24 year-olds to pony up while casually letting the destitute slip through the cracks will somehow yield better outcomes.

The fantasy is that American society is somehow exceptional in that it can’t provide dignity to its citizens, that There Is No Alternative to cruelty and cynicism.

The fantasy is that a shitty Court is somehow responsible for piss-poor legislation.

Credit where credit is due, mon frere. I phone banked in ’08. My spouse went to Ohio to monitor for election fraud. The enemy was us.

Perhaps one of the most stunning examples of intellectual tomfoolery appeared on the Forbes-magazine Web site on September 23. The piece—which maintained that Obamacare would add a total of $7,450 to the average health spending of a family of four over the next eight years—quickly went viral as conservatives grabbed onto it as proof that the health-insurance program would wreck America.

Sigh. Unfortunately, this piece may well be the silliest, most intellectually dishonest piece of drivel to be published since the adoption of Obamacare. Where to start? The author of the piece—Chris Conover, an adjunct scholar at the American Enterprise Institute—begins by quoting Obama as stating in 2008 that his administration would lower insurance premiums for Americans by up to $2,500 a year for a typical family. (I’m not going to defend Obama’s argument—it, too, was a silly assertion.) But then— ah hah!—Conover points out that health-care costs are predicted to go up by $621 billion in the first 10 years under Obamacare.

Let’s expose the first problem in the simplest way possible: insurance premiums are not the same as health-care expenditures. Perhaps an analogy will help: I am going to give you coupons to save you $250 in your food purchases over the next year. But then I decide not to because—ah hah!—the grocery store issuing the coupons is predicted to earn an additional $62,000 more in sales during that same time. Catch the trick? I start by talking about savings in premiums—the coupon—and then compare it with total amount people are spending on food at that location. And the two numbers have nothing to do with each other! While the coupon probably causes the increased sales in part by bringing in more customers, it doesn’t mean the average cost for all shoppers goes up. When more people get coupons—in this case, insurance—there are going to be more expenditures—in this case, health-care costs—as more people flood into the market.

So, saying “when more people get health insurance, the amount spent on health care will go up” is sort of like arguing that when you dip something in water, it will get wet. Yes, when there are more people who can get health care, more people will get health care, so the amount spent on health care will increase. But Conover pretends there is some link between the obvious and how much people will spend on premiums. People who currently have policies will not be affected at all by this increase in health-care spending.

Then, Conover engages in some truly eye-popping sleight of hand. He takes year-to-year healthcare spending projections, divides them by the projected United States population, and then multiplies that answer by four to see what the average family of four would spend. No, really—that is what he did. He makes no accounting for the fact that the entire market has changed—that tens of millions of people who were previously uninsured suddenly have full access to the health-care market. What matters is not the population of the United States, but the total number of insured and how the addition of these millions of insured will affect health-care usage—and believe me, the probability that health-care usage will increase as more and more people get accustomed to having insurance is 100 percent. And remember something else: using health-care services means more health-care services will be used. Medicine keeps people alive; the greater number of people who have access to it, the longer they will live, the more they will keep accessing health care.

Banger’s right, and your comments are the product of “loser liberalism” because they rationalize and excuse the acts of the Democrats. Making the Democrats accountable means blaming them when they ‘eff up. That’s what they’ve done since 2009 and before. That’s what they’re still doing and that’s what’s caused all the costs I listed in the article.

Btw, look at the table. I did compare the ACA to nothing at all. It’s in the baseline. The comparison shows that the ACA will save lives compared to nothing at all; but it also shows that it will cost 286,500 lives compared to HR 676, which the Democrats clearly had the sheer political power to pass in March of 2009, assuming they had eliminated the filibuster in January when the Senate convened. If the Democrats had intended to represent their constituents and implement their mandate they would have used the constitutional option before passing any legislation at the beginning of 2009. However, Obama did not ask Reid for that, and Reid care too much about the filibuster to do it without pressure from the White House. Bottom line: the Ds gave the game away, and not to recognize IS “loser liberalism.”

If you think Banger, and the two twits from Forbes were right on costs, you need to change your information sources.

Those numbers are comparing apples to oranges when they are accurate, and outright bs when they are not.

And Loser Liberalism is what you are doing. Attacking the first positive legislation to deal with our healthcare problem in half a century becuase it is not what you wanted is loser liberalism. And it is why liberals have been liosing since Reagan.

What lousy team players most liberals are. It is not a bad thing to fight over policies and procedures in the locker room, it can actually be a good thing.

But when that fight is taken on the field against the opposition, it is a disaster.

AYou are helping the Kochs and petersons of the world, in addition to the great unwashed that is the Tea Party.

ACA sucks because it sucks. We had the world’s worst health care system before it, and American ingenuity figured out how to make it worse. I am never partial to “it has to get worse before it gets better” arguments, but sometimes it works out that way. That’s the only argument for Obamacare.

Health care should be a form of infrastructure – obviously the public good is self evident. What we have with ACA is an insurance policy – the policy insures the profits of the insurance industry. So much mayhem is being made over who get the surplus/profit .. like pigs at the trough. Of course this insured profit comes at the expense of those needing medical care – those needing care are definitely not at the trough…they are to be content with whatever scraps make it to the ground and beyond the hoofs of said swine. Of course, being outside the the circle of pigs around the trough implies being on the south end of a north bound pig – expect to get dumped upon

Ummmm, it’s a fantasy to think that paying for government health programs with taxes is necessary. The US Government (including Congress) is the ultimate authority when it comes to creating money. If it chooses to pay for its health programs with newly created money, then it can do that.

Now you are getting into the complexity of “money.” Money is not what it was–it is pure fantasy–it is Monopoly money pure and simple. Its value is based on government decree and what the market will bear.

The argument for printing money is simple. If you use this money as an investment with a guaranteed return you only have to worry about the market. The markets will look at this additional money and gauge if the currency can still maintain its value against other currencies. If the market knows the returns will be a net-positive it will discount the inflationary aspects of printing money to some degree, since it will improve the quality of life and, as has been shown, will improve productivity. People who are less stressed and healthier will produce better and learn better and faster and, ultimately, the strength of a currency depends on the health of the people in the country.

The printing of money will be somewhat inflationary but it would probably not be more than the interest rate the gov’t would have to pay to rich investors.

Well, I was asking Joe. Joe seemed to be suggesting that the entire additional amount of public expenditure for an expansion of the public role in health care can be generated by running larger deficits rather than raising additional revenues.

You make a lot of confident assertions about the effects of printing money in the present circumstances and in the future. On what are they based?

Intuition and a lifetime of observation. Quantitative easing, the results of stimulus spending and so on all show that printing money (which is what deficit spending and QE could be described as) shows that the U.S. more than any other country has a lot of “give” in the value of the dollar. The U.S. can spend a lot of money without revenue and still maintain a relatively high level of value on the dollar. If money were to be raised to increase productivity why wouldn’t it result in modifying inflationary pressures? Do you have proof that I’m wrong?

What is this obsession with “proof”? We are not in a professional situation or a court of law but rather throwing around our ideas and reactions to posts. At any rate, I get that you categorically reject what I said and see no merit to it.

Quantitative easing doesn’t prove anything, because it is a swap of one financial asset for another, and it takes place almost entirely on the accounts of financial institutions. That’s not the same thing as pumping dollars into the economy.

“I think they would have succeeded because Nancy Pelosi had full control of the House, and with elimination of the filibuster and even reconciliation they would have needed only 50 votes + 1 (the VP) in the Senate to have passed that bill in the Spring of 2009, and implemented it by January 2010. Then there would have been no rise of the Tea Party, no sabotaging of the ACA, and full coverage for everyone with no co-pays.”

The filibuster would not have been abolished as the Democrats know they oculd be in the minority in the Senate in the future.After all if you abolish the filibuster in the future when the Republicans have the majority some time, then they could push thru want they want. You notice that every time it has been talked about in terms of confirmations, eventually a comprise has occured because of this fact. The Dems know they might need the filibuster rules in the future.

What’s your point? Do you think Dennis would have been whisked away if HR 676 were passed, the rise of the tea party was avoided along with the Republican sweep of 2010 and the big 10 year gerrymander? Don’t be ridiculous. If the Ds had acted like Ds used to act from 1933 – 1970, we’d be living in a different world now.

No the Tea Party mentality had been building for some time. But the ACA did empower the TP and its funders by showing the weakness of the left. A rational health-care reform bill or series of bills would have rallied the left and forced the media to report the facts about health-care in this country compared to the rest of the developed world and would have, eventually, filtered down to most of the population. This is the fatal flaw of the ACA that you just don’t get. Obama and the Democrats did not want to offend their friends in the medical industry who have provided very lucrative jobs to staffers and operatives (I know Washington and I know operatives who got jobs in the industry after Clinton left office). They deliberately excluded the FACTS about U.S. health-care form the “debate” knowing the mainstream media does not report anything that a Democrat or Republican doesn’t talk about, or to be precise, they report it once and then forget about it. Case and point–I had a friend who was in Salvador as a reporter, in the eighties, and his pub like every single mainstream pub one day decided that there was “no story there” and they were all recalled. The Death Squads were still there but the Democrats decided not to push their opposition to U.S. policy in Latin America at the time.

Again, for the 20th time, PPACA doesn’t have the structure it does because of attempts to get Republicans on board. It was structured the way it was because Democrats didn’t want to have to pay for it with taxes. They still don’t want to pay for it, and that isn’t likely to change.

I think that Firestone would be more convincing, and the argument for single payer would become stronger, for those we vote to serve lobbyists and donors instead of (and against) us, if he acknowledged this. It wouldn’t hurt to also acknowledge the handful of DEM reps who voted yes for the ACA, knowing that they would lose in 2010 (and lose their revolving door futures, too). It sucks that this is how things work, but ignoring it doesn’t help.

Their rationale for proceeding in the way they did was to have something bipartisan. I agree that wasn’t the dominant reason they did things the way they did. But it was one of the reasons and in evaluating them it’s relevant to point out that after accepting a whole raft of Republican amendments to their proposal, they still did not get a single Republican vote.

Moreover, when they didn’t get a single such vote, they should have rammed through the constitutional option to get rid of the filibuster, and gone back to HR 676, since as long as the Rs were going to deny them all political cover anyway, they may as well have gotten hung for a sheep as a lamb.

“The health law cuts into government spending, but that’s not its only source of funding. The law also raises new revenues as it expands insurance. Some of it comes from the provisions you’ve probably heard a lot about: A tax penalty for those who do not purchase coverage generates $55 billion over the course of a decade. An excise tax on the most expensive, so-called “Cadillac” insurance plans, nets $111 billion.

But a lot of the money comes from less exciting parts of the law. The CBO expects to see $216 billion saved from the positive side effects of expanding insurance, like less reductions in uncompensated care. Another $318 billion is generated by having those who earn a gross income over $200,000 pay 3.8 percent of investment income toward Medicare’s hospital insurance. Here’s how it all breaks down”

The patient is lying on a table in the ER suffering a maasive corronary, in diabetic shock, bleeding out of his femoral artery, and the geniuses who believe they understand the underlying etiolgies are obsessing over his in-grown toenail.

The problem with this health care system is that it is not a health care system, but instead, a sick care system, designed to produce billions for the corporations the run it.

The notion that you can repair, replace, and fix 315+M people’s body parts in the U.S. is absurd. The only solution is prevention-only.

People need to take responsibility for their own health by doing what they can to keep themselves healthy. Beyond that, a free market of individual healers can help where natural, inexpensive treatments may provide relief, but to create a system where bankers [insurance companies] collect money and redistribute it can be nothing other than a complete calamity.

People will always get sick, age, and die. It is the natural course of our life-cycle.

I agree that prevention should be central to any system and we have, in this country, great alternative health-care providers (and some terrible ones too). But, people still buy into the medical model and official medicine is beginning to follow science and understand that stress, trauma and social issues have a lot to do with health. The science of health is way, way, way beyond where health-care is but it is catching up.

But the problem is that many people don’t get very basic health-care early because they are uninsured or underinsured. A rational health-care system would address basic needs without the outrageous costs that are a feature of our system. Look around the world and you will see that every developed and some developing countries have rational systems, i.e., they aren’t dominated by outright thievery. We could afford both a basic medical-based system and an alternative-care system easily if the former was rational.

I was cut off above when I hit “return” for a new line.
If anything, the situation is worse. Pelosi NEVER thought of introducing a public option — and ALWAYS opposed it with real hatred, combined with money-lust for insurance industry contributions.
Dennis Kucinich tried to introduce the public option for vote. Pelosi would not even let him BRING UP the topic at the House meeting. She blocked even a DISCUSSION of whether it might be discussed.
So the fate was fixed at the outset. When Dennis persisted in trying to push for a public option, he was stripped of his committee chairmanship and the Democrats threw their support behind his rival in the gerimandered Cleveland district.

Thanks, Michael. So as I said the Democrats ARE to blame for the 286,000 fatalities we are having and will continue to have. Of course, the Republicans are to blame too; but that goes without saying. In many quarters however, there’s still a disposition to blame only them, and view the Democrats as victims of Republican perfidy, rather than as collaborators in our increasingly rapid migration to the unjust society.

“Here is what happened. After a year of deliberation and wrangling, the Democratic-controlled House and Senate each passed a different version of health care reform in 2009. On November 7, the House passed its version of the bill on a 220-to-215 vote. On December 23, the Senate voted 60 to 39 to end debate on the bill, eliminating the possibility of a filibuster by opponents. The bill then passed on a party-line vote of 60 to 39 the next day.

Soon after the Senate passed the Affordable Care Act, Scott Brown was elected to take Ted Kennedy’s seat and the Democrats consequently lost their filibuster proof 60 votes in the Senate. Consequently, the most viable option for the proponents of comprehensive reform was for the House to abandon its own health reform bill, and instead approve the Senate-passed bill. They knew they could not get an amended bill passed by the Senate since they would not have 60 votes to end a Republican filibuster. However, a number of House Democrats who had reluctantly backed the president on health care reform didn’t like a number of provisions in the Senate version of the bill such as a provision that would have provided a higher rate of Medicaid reimbursements for Nebraska – the so-called “Cornhusker Kickback” that was designed to win the support of Democratic senator Ben Nelson of Nebraska.

House Speaker Pelosi made a deal to get the reluctant Democrats to go along with passing the Senate version of the bill. If they would vote for the Senate bill, then the Democratic leadership agreed to immediately introduce and pass separate legislation under Budget Reconciliation amending the Affordable Care Act to address those members’ grievances. The House passed the Senate bill on March 21, 2010 by a vote of 219 to 212. The Patient Protection and Affordable Care Act was signed into law by Obama on March 23, 2010.

Pelosi then introduced the Health Care and Education Reconciliation Act of 2010
to make changes to the Affordable Care Act. The Democrats used reconciliation to pass the amendments. On March 26, 2010, the Senate approved the amendments, 56 to 43, and the House passed them, 220 to 207. Obama signed the Health Care and Education Reconciliation Act of 2010 into law on March 30, 2010.”

If ObamaCare advocates were acting in good faith they’d already be pushing for improvements — like when “progressives” were going to hold Obama’s feet to the fire. Of course, they aren’t, and they aren’t. too busy waving their pom poms, I guess.

I don’t expect universal health care in the United States anytime soon at least one that both liberal and conservatives groups and those in between could agree upon. I have become overwhelmed at the constant bitching against and fore everything that can be framed within a political context that is constantly broken down into meaningless bits of information as if alone or together these thoughts form some unique interesting or new point of view.

The health care law was passed not perfect and I for one am tired of hiring about how terrible both parties are in relation to health care because that is NOT news or even interesting reading. I get it that Democrats are big business and Republicans are big business and neither party has the peoples interest,I think most if not all the readers on this site get it.

That’s true; but not on point. Sometimes “bad” may be bad enough that it’s still unacceptable, even if worse is even more so. 286,000 fatalities is unacceptable, even if it’s better than 564,000 or 648,000. In addition, all the opportunity costs of passing the ACA could have been avoided.

So, the Democrats passed something unacceptable when they had the opportunity to pass a number of things that were much better. Also, had they stubbornly insisted on enhanced Medicare for All and then been defeated, they could have then built a movement for its passage in 2011, and won the elections of 2010. That would have saved at least 190,000 lives off the ACA total, and most of the opportunity costs affecting fiscal politics, the economy, State level idiocy, and the war on women would have been avoided.

If you are right, and what what Joe F says could have been done wasn’t possible, then the Democrats should go the way of the Whigs, ASAP.

And on “light years,” no. 564,000 286,000 = 278,000 so you’re off by several orders of magnitude. This would be a pardonable exaggeration, did it not show so clearly the sociopathology of “lesser evilism.” An admitted humanitarian disaster like 286,000 excess deaths is greeted with a “Ho hum! We just couldn’t do any better [sigh].” Dear Lord.

In addition, if the Democrats had supported real health-care reform which would have happened and would have passed then the deaths would have been a fraction of that number.

My thesis is that “if” the Democratic weren’t thoroughly corrupt (and it is) they would have presented the American people with the facts surrounding health-care in this country. These facts are unambiguous and would have supported a rational reform based on dozens of examples from other countries most of which don’t have single-payers (a fact virtually unknown in this country). The facts would have been impossible to counter.

The deep corruption (and I know what I’m talking about having spend most of my life in the DC world) of the Democratic Party means that nothing can be done other than put the odd bits of duct tape here and there.

It is all based on the thought process that a publci option could have been done. There is nothing I have seen that says that was possible.

Of course, we then have firstone coming up with “what would have happened” if the Dems just dumped the ACA. None of which are any but speculation. (btw, I love the part about the 2010 election changes, like almost every Presdiential party does not lose seats in Congress in the midterms)

So let me speculate. The Dems drop the ACA and bloame the Reps. The Reps, starting with Brown in January, gain the same seats they gained in the midterms. There is no healthcare rform at all. So your insistence, and Firestone’s, on speculating how things would have changed, are wrong.

There is no reform at all. And we go back to the 564,000 deaths due to our system.

Alas, it was patently obvious that Obama aborted single payer in utero, even shutting out his own former physician, cut opaque side deals with Pharma, and made only the lamest, half-assed gesture toward a public option. The great solver-tongued orator was stricken deaf and dumb WRT anything remotely progressive in ACA. In essence, all that remains is an “effing retarded” insurance-pharma racket bailout.

I get it, your tired of the bickering and wish that we all just hit the snooze button and accept the status quo. Complacency uber alles.
Or how do you propose that we even begin to build the political space to oppose those who are using our health care as a profit center, if we can’t even talk it about ffs?

I must say that I really “feel” for those readers who find the “tone of the conversation” distressing, ’cause “they ain’t seen nothing yet!”

Just wait to the tens of millions of group health beneficiaries feel the full impact on their policies (or get thrown into the Exchange, and not be eligible for a “subsidy,” even though their premiums rise exponentially!

Oh, and let’s not forget that Dems are pushing to disallow a tax exemption (in place for decades, as I understand it) for “Group Health Plan Beneficiaries.” You know, the same folks who stuck it to, and now can’t “help” the unions, but carved out cushy deals for themselves and their staffs, etc.

I’m actually looking sort of forward to seeing the reaction when these folks “wake up!”

2016 will be the year of “Third Parties” on BOTH sides–mark my words! ;-)

What the ACA saves is the insurance companies. For this we get some sort of marginal advantage — if our income sucks, we’ll get subsidies to buy insurance. Can we afford to use said insurance? Hard to say. Will the insurance companies find loopholes in the 900 or so pages of the ACA to deny us coverage? Hard to say.

The one certain thing out of all of this, then, is insurance company profit. Obama’s a good neoliberal.

And the profit is restricted. Of course, let’s not talk about how many people will be covered by the expansion of Medicaid, or give specific amounts of coverage costs, instead let’s worry about it will cost too much and insurance companies denying coverage against the law.

Course, we could also wait and see.

Or, we could have just done the GOP plan and see if somehow the status quo totally reversed itself. Y’know, the one that allowed insurance companies to basically do whatever they wanted and spend however little they could on healthcare.

It cannot be said enough: the “subsidies” the ACA will pay all go to insurance companies, with profit of 20% or so built in.

Obama has delivered for corporate health care. Obama negotiated away drug price negotiation by the government and reimportation at a cost of many lives and financial pain. Obama lobbied against allowing House passed forms of single payer legislation for even getting a vote in the Senate so he could get HIS and Wall Street’s preferred Heritage Foundation plan. Obama only gives a sh#t about health care to the extent it makes more profit while helping some people. Obama fully acceptsa that tens of thousands will ciontibue to die each year just because they don’t have enough money.

The ACA is designed to funnel more money and profits to the least efficient health care system in the world. Obama sees the additional lives that will be helped as the glass being full. The tens of thousands per year that will continue to die he won’t acknowledge, and he intentionally confuses having health insurance with being able to afford heath care. The is no half empty glass in salesman Obama’s world.

This article suggests that since no Republican voted for the ACA, the Democrats were capable of passing Medicare for all in its stead, and so guilty of betraying their base. But that is not the case: opposition feom within the party was always the biggest obstacle, and keeping the insurance companies from waging a propoganda war on reform. Not that all you armchair jocks could do better. As I like to say: its the system, stupid!!!

I agree. The Democrats pushed hard to elect Blue Dogs in the House. Actually, if memory serves several of these voted against Obamacare. In the Senate, there were seven or eight Senators, like the Nelsons and the ultra-corrupt Landrieu, who would never have gone for anything remotely good for the 99%. And lets not forget Obama. Obama always wanted this corporatist vision of insurance and was always opposed to Medicare for All. On a couple of occasions he said that a public plan was not in keeping with American culture and history, even though one out of every two dollars spent on healthcare in this country comes from the government.

It contends that the Democrats could afford to lose 8 votes in the Senate and still pass Medicare for All, and, of course, they had a huge House majority. But the important thing is the leadership. If Obama had wanted that passed, he could have gotten it. Reid knew that he needed Obama in 2010; so Obama could have had him eliminate the filibuster if he wanted to. Once the filibuster is gone, the power of individual Senators is much reduced, and Reid would certainly have been able to get those 50 votes, while Obama could supply Biden’s

In the House, Pelosi had control of the Democrats. She could get exactly what she wanted, and Obama had her in is pocket. So, I’m sorry, but I think you’re way off base. Obama could have passed MFA if he’d wanted to do that.

You are assuming facts not in evidence. There is zero evidence that the Democratic Senators who passed the corporatist Obamacare would ever have supported Medicare for All. We do know that Medicare for All was kept off the table by virtually everyone involved in the media, the Congress, and the White House. Further, the vote on Obamacare in the Senate was 56-43 and three Democratic Senators voted against it: Nelson of Nebraska, Pryor and Lincoln of Arkansas. This was done through the reconciliation process which was allowed for those elements of the ACA which involved spending. This precluded a filibuster and a 60 vote threshold for cloture, that is only a single vote and a simple majority were necessary for passage.

In the House, the vote was 220-207 with 3 not voting. No Republican voted for Obamacare. The breakdown of the no votes was 175 Republicans and 32 Democrats. If memory serves, the Democratic no votes all came from Blue Dogs. All the so-called progressives in the House voted for the ACA. This was due not so much to Pelosi as to Obama. Who can forget Kucinich’s sudden conversion/betrayal after a ride with Obama on Air Force One?

I have no idea what you mean by Reid needing Obama in 2010. Through much of that Congress, the Democrats had a working majority of 58 (56 Democrats and 2 Independents). The Democrats lost 5 seats in the 2010 elections, largely because of their identification with Obama’s policies. Meanwhile in the House, Democrats lost 64 seats and control of the chamber. Many of these were Blue Dogs. Why vote for a Democratic DINO when you could vote for an authentic Republican? The irony was all the effort that people like Rahm Emanuel had put in running the Blue Dogs in the first place at a time when liberal and progressive candidates could well have won, and kept, those districts. Well, irony is perhaps the wrong word because Obama and Emanuel weren’t liberal and they pushed these kinds of candidates precisely because they were so close to them and their corporatist views ideologically.

The mistake you make is to assume under any circumstances that an anti-progressive, anti-99%, pro-corporatist President, and a Congress with zero authentic progressives in it, would ever support Medicare for All. They would not. They did not. They did not fight for it and fail. They did not sit passively by. They actively sought to suppress any debate, down to even any mention of it.

Hugh, My narrative assumes the condition that Obama would have acted in an entirely different way upon coming in. Of course, I grant he didn’t act that way. I’m criticizing him for not doing so. That’s the whole point. Here’s what I’m thinking could have happened:

The secret was to secure the power first to do the most important things that needed to happen first. This could have been done by getting rid of the filibuster, and having Reid remove any recalcitrant committee Chairs. Then you start building political credit among the population. How do you do that?

1: Prevent the abandonment of the mark-to-market rule;

2: Immediately take the then insolvent big banks into resolution so there are no bailouts and they are removed from the political picture, while also having them lower their credit card interest rates to 5 points above the FFR;

3. Once you have their books; investigate, prosecute and indict the control frauds in the big banks, while stopping the foreclosures (by this point the political power structure is already changed, and the Ds representing the financial interests are thinking twice about whether their future lies there).

4. Pass Christine Romer’s recommended stimulus bill, reportedly coming in at $1.8 Trillion (this assumes that there’s no time to get MMT accepted);

5. Pass a CCR reform bill limiting CC interest to five points above the FFR for every CC company and subsidiary;

6. Complete this by the end of March (speed is everything so the opposition cannot organize);

7. Turn to health care; just get behind HR 676 and get Reid and Pelosi to prevent any hearings or committee palaver (HR 676 is an old bill, repeatedly introduced into Congress every two years, so no need to study it); then ram it through and sign it. Do it by the end of April, Obama’s 100 days,

8. And this is key to making it happen, implement it in the next 6 months. Get it live by November 1, 2009, and while you’re doing it promote the hell out of it constantly emphasizing how much money people in every State will save and how much coverage they will get for free. Campaign it, match all the talking points, while pleading with people to wait to experience the reality.

Results? Yes, there all kinds of people would have been hopping mad at the Administration. But by November, unemployment would have been dropping like a stone and people would start feeling the effects of the enhanced Medicare for All Law. Also, credit would have been flowing freely because the Government people in control of the banks being resolved could have seen to that.

By early 2010, assuming Romer’s bill, high unemployment is over, corruption at the banks is at an end, and health care is accessible to everyone. So, tell me, how could the Republicans and blue dogs have stopped that if Obama had gotten Reid aboard? With the filibuster gone the Leader can schedule the votes he wants, when he wants them. Then all Ds have had to go on the record for or against MFA. 67% of the population favored Medicare for All at that time, probably still do. Would more than 9 Democrats have voted against it in April of 2009, with Teddy Kennedy still alive. Name them. I don’t think that many would have been willing to expose themselves as faux Democrats. You named Nelson, Pryor, and Lincoln. I don’t think I’d give you Pryor if there had been a vote on MFA. But anyway who else? Lieberman, Landrieu, Bayh. Even with Pryor that’s only 6. So, who else would go on record against it. And even if 9 could have been found, if Obama were really committed to it; then he could have hedged by proposing compromises that hedged according to age, say everyone 50 and under 26. That would have covered a lot more people and placed the handwriting on the Wall, and it would have been far superior to the ACA, since we’re talking about enhanced MFA with no co-pays.

I agree that the bought Obama didn’t do that; but my argument is and always has been that he could have done that and I won’t let him off the clock by claiming it was impossible because of all the corrupt Dems in Congress.

You said:

“I have no idea what you mean by Reid needing Obama in 2010.”

What I mean is that Reid was likely to be vulnerable in 2010 in a purple state. He only won because he ran against an idiot TP candidate. Certainly he would have seen at the beginning of 2009 that he needed the strong support of Obama in 2010. If during the last part of December Obama had told Reid that he needed him to get the filibuster ended when he organized the Senate on January 3, 2009, then I don’t think Reid would have been in a position to turn him down. As for Pelosi, she has been Obama’s most loyal creature since he became President. She would have guaranteed a majority in the House for enhanced MFA.

Great post. Untold millions of Americans already have crappy insurance and as a result, untold thousands or tens of thousands of them die each year, and equally untold tens of thousands of them go bankrupt even with insurance. At the same time, most Americans in the run up to Obamacare have seen their insurance premiums, copays, etc. explode, resulting in many being pushed in or toward the crappy insurance end of the spectrum. What Obamacare will do is push millions of uninsured, and certainly there are many questions about how many, into crappy insurance that they will find difficult or too expensive to use. So how many deaths and ruined lives will continue under Obamacare is a very important question.

Finally, the discrepancy between the 45 million uninsured and Obama’s target 31 million is essentially the undocumented. I suppose you could argue this either way. It won’t do a lot for them to force them to buy crappy insurance just as it won’t help those Americans who are forced to buy it. You could even say they come out better than citizens in this. From a public health perspective, both those forcibly insured and those who are left uninsured represent a significant potential public health disaster as well as an ongoing stain upon the humanitarian values of our society.

The idea is that the undocumented would stay away from healthcare for as long as possible, increasing their mortality, the severity of their illness when they presented (and hence the level of care needed for them), and the time they would have to pass any disease on to others, not just among the undocumented but among the general population.

“At the same time, most Americans in the run up to Obamacare have seen their insurance premiums, copays, etc. explode, resulting in many being pushed in or toward the crappy insurance end of the spectrum.”

geez from the WSJ(for god’s sake)

“The prices paid for medical care in July rose just 1% from a year earlier, the slowest annual rate of growth since the early 1960s, according to Commerce Department data. Health-care increases now trail overall inflation, which itself has been historically slow in recent years.

The price data help explain why growth in overall health spending has slowed down in the past several years. The trend, if continued, has big implications for the government’s finances because health-care costs are the biggest long-term driver of the federal deficit.”

How has the NHS in UK and Medicare in Canada tackled costs?
=====================================
In one short phrase they have imported boat loads of Physicians from India and Eastern Europe and simply all over the world. They also do not have this insane ‘fee for service’ nonsense. People who want the private ‘Free Market’ are welcome to move to Harley Street if they have that much money to spare and be Physicians to the rich millionaires and billionaire hypochondriacs that you come across in ‘Bramwell’.

The first thing we need to do in the US is to break the guild that is called the American Medical Association. It would be called a Union if it were not for our craven Corporate media. To give them a little credit though, the Time Magazine article on Healthcare ‘Bitter Pill’ does expose the sham of how the AMA basically decides on what the ‘Fee’ for the ‘Service’ will be every year and how our craven politicians simply nod their heads and accept the extortion.

One way by which we can break the AMA is to immediately pass legislation enabling a new medical visa program through which we can allow companies like Wipro and TCS in India to recruit specialist and primary care Doctors and bring them to US soil on 10 year visas. This will drive down the ‘Fee’ in the ‘Fee for Service’ model instantly.

This was how Engineers salaries were driven down. It’s a solidly working model with a 20 year proven history. Engineer salaries became static or driven down in the US in the last two decades since H1-B visa legislation was passed and diluted in favor of importing engineers direct from India.

We have very good precedence for doing this because the US Army did it. A recent MacaArthur award went to a woman who came up with this idea of granting US Citizenship to people who are here but who are not citizens. They ended up recruiting Ph.Ds and other highly qualified candidates that the Army in normal course could never attract.

On a parallel track we need to undertake approval and opening of new Medical Colleges and Teaching Hospitals on a war footing coupled with free tuition for any student who gets a certain minimum score in the MCAT. The MCAT should also be held in centers AROUND the World.

By the way, it used to be held in India once upon a time but since Doctors in India were becoming very clever and acing the exam and coming over to the US in large numbers, the AMA (White Male Caucasian Doctors got very frightened) got cold feet and banned the exams from being held in India. THe reasons were that the question paper got leaked a couple of times. These days this is no longer a valid excuse since most of these exams are not computer based and totally un-crackable.

Medical costs will come down steeply in the next 10 years if we do all this.

Well, if setting the record straight and holding people accountable for decisions made is “pointless scab-picking,” I suppose we’ll just have to agree to disagree. For myself, I think both are essential to improving ObamaCare, supposing that to be possible, or replacing it with a system that can actually be shown to produce cost-savings, universal coverage, and better health outcomes. Your mileage may vary, and apparently does.

I don’t know. I have seen precious little discussion on this site about improving ObamaCare. There is a lot of “what if” discussion, and a lot of “Episode 17: Why Obama Sucks” discussion. In fact, I would say that the commentariat of Naked Capitalism, as a general rule, seems absolutely obsessed with the person of Barack Obama, and is interested in talking about little else but him, despite the fact that he is no longer running for anything.

Last I looked you were part of the NC commentariat Dan. But apart from that, I think you’ve gotten up on the wrong side of the bed this morning.

Evaluating Presidents and political parties is never out of order in a democracy. It’s part of the process of holding people accountable. That’s especially true when both parties want us to forget history and never stop thinking about tomorrow.

The Democrats made some choices in 2009 and 2010 that is costing hundreds of thousands of lives that has had a nasty political impact resulting in far greater economic austerity than we had to suffer. MMTers such as you and I always complain about austerity and rail against stupidity of both parties in implementing it.

While this is on point, it’s also true that there would have been a lot less austerity here over the last 4 years if the Ds had gotten rid of the filibuster and followed that with enhanced Medicare for All. They and we would then have avoided the Republican sweep of 2010, and we might well have had much less austerity, and even a few attempts to create some jobs during the past 2.5 years.

The difference is you seem to be positve the Supreme Court would have followed the Constitution and allowed everything you say would have happened to actually happen.

My first post in this topic:

“And while we are living in our liberal fantasy world of the “reconciliation” and “getting rid of the filibuster”, we have to make sure we also forget the Supreme Court and their actions the last decade or so.

We have to make sure that we cannot allow ourselves to think it is possible this court could interpret Article One, Section 5 of the United States Constitution in ways that would have disastrous effects on our government while our fantasy is played out.

After all, just because we have watched this group rape the First Amendment (Citizens United) and the Commerce Clause(ACA), there is no reason to think they may actively apply a never before seen interpretation to the Constitution that would allow government by the minority, or at least no government by the majority.

Joe, NC has been evaluating the president day-in and day-out, rather incessantly, for some years now. On the other hand, it seems to be little interested in participating in the organization of anything beyond blind rage. And when Yves wrote her recent paean to to hopelessness and pessimism, the commenters toasted it it as the height of philosophical enlightenment and sound thinking.

At the same time, some of the most vile and ignorant human beings ever to serve in our government prowl the halls of Congress. I would say the attention given by NC to Obama vs. the House troglodytes runs about 30 to 1. They receive, if not a free ride, something like a nickel ride.

Now, at the very moment went the Republicans in Congress are attempting to use a government shutdown and/or debt ceiling standoff to dismantle ObamaCare, you guys have chosen to double-down on the Obama attacks. So I assume you want them to succeed.

OK. Now I see where you’re coming from. Not every post is a demand for immediate action. And I didn’t write this one for the purpose of supporting the Republican effort to defund ObamaCare. Of course, I’m opposed to that, and entirely opposed to the shutdown.

On Obamacare, I wish it had been implemented in 2010, and certainly think it should be now. The quicker it is implemented, the quicker will become aware of its faults and the quicker it will be possible to build the Medicare for All movement once again. That said, a post like this pointing out the shortcomings of Obamacare and how far it is from what we need, helps to keep one’s eye on where we want to be and so is beneficial.

On this site’s orientation to writing and criticism rather than organization and action, as Lambert says it’s a big Internet. If NC prefers to contribute through blogging and does that well, which I think it does, then that is a valuable contribution to moving things forward, in my view.

Other sites, like FDL and Kos do organize. But don’t do as good a job at blogging in my view.

Finally on this:

“At the same time, some of the most vile and ignorant human beings ever to serve in our government prowl the halls of Congress. I would say the attention given by NC to Obama vs. the House troglodytes runs about 30 to 1. They receive, if not a free ride, something like a nickel ride.”

Again, it’s a big Internet. Many of us including myself, believe there is an abundance of criticism at a variety of sites of the troglodytes in both the House and the Senate. Everybody, from the Center to the village left does that non-stop. At the same time, these same outlets have said nary a word about Medicare for All since Obama took it off the table in 2009, They also reflect White House framing on most issues to the exclusion of progressive alternatives. They pretend that Obama can do nothing at all about the Republicans intransigence on the debt ceiling except shut down the Government or cave, when by now many of these outlets have heard that there are alternatives the President can embrace. These same outlets have failed to criticize his feeble efforts at reducing unemployment, and for them utopia in regulating business is the Dodd-Frank bill.

All our energies are limited, so we have to allocate them where it will do the most good. I don’t think directing my fire at the troglodytes and playing the Administration is the best use of my blogging time. I think that best use is unmasking so-called progressives who won’t tell the truth in evaluating the Administration and its performance. We desperately need to move the overton window to the left. We’ll do more for that objective by “unmasking” the so-called “left,” than we will by attacking the troglodytes.

I am sorry, but “pointing out the shortcomings” in Obamacare has nothing do with coming up with a fantasy healthcare program that could not happen and using that fantasy to blame Obama for the deaths of “286,500” Americans.

If you want to understand American politics as it is an examination of health-care politics is essential since it makes up 18+% of the GDP. This is huge. The stakes are very high and an examination of how the ACA is structured and how it was implemented is important–if you are interested in how American politics works–it is a perfect case study.

Hey, I worked really hard for my Ph.D. staying up till 3:30 AM quite a few mornings in those good old days. And while I did it, I learned how to do research, a skill that I don’t see too many sharing nowadays.

Anyway, I agree with Lambert. If you’ve got something factual to say then we’d be clear to hear about it. Otherwise go back to your Obot sites.